The Congenital Heart Technical Skill Study: Rationale and Design
Brett R. Anderson, MD MBA MS1, S. Ram Kum, MD PhD2, Danielle Gottlieb-Sen, MD MPH MS3, Jane W. Newburger, MD MPH4, Kevin D. Hill, MD MS5, Francis X. Moga, MD6, David M. Overman, MD6, Marshall L. Jacobs, MD7, Jeffrey P. Jacobs, MD8, Sherry A. Glied, PhD9, Emile A. Bacha, MD1.
1Columbia University Medical Center, NEW YORK, NY, USA, 2Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA, 3Children's Hospital New Orleans, New Orleans, LA, USA, 4Boston Children's Hospital, Boston, MA, USA, 5Duke University Medical Center, Ralleigh, NC, USA, 6Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA, 7John's Hopkins School of Medicine, Baltimore, MD, USA, 8Johns Hopkins All Children's Heart Institute, St. Petersburg, FL, USA, 9New York University Robert F. Wagner Graduate School of Public Service, NEW YORK, NY, USA.
Objectives: We report the rationale and design for a peer-evaluation protocol of attending congenital heart surgeon technical skill using direct video observation.
Methods: All surgeons contributing data to The Society of Thoracic Surgeons-Congenital Heart Surgery Database (STS-CHSD) are invited to submit videos of themselves operating, rate peers, or both. Surgeons may submit Norwoods, CAVCs, and/or arterial switches. A HIPPA-compliant website allows secure transmission/evaluation. Videos are anonymously rated using a modified Objective Structured Assessment of Technical Skills (OSATS) score. Ratings are linked to the 2012-2017 STS-CHSD and surgeon questionnaires. The primary outcome is major morbidity/mortality.
Results: 136 surgeons from 43 centers met initial eligibility; 54 surgeons (40%) from 28 centers have already agreed to participate. These surgeons vary considerably in years of experience and outcomes (Fig 1). Participants often described the process “very rewarding” and “less time consuming than anticipated”; many had not realized that they “did not have to edit videos” or obtain IRB approvals or consents. An initial subset of 8 videos demonstrated excellent inter-rater reliability (ICC=0.86).
Conclusions: This study proposes to evaluate the technical skills of attending pediatric cardiothoracic surgeons by video observation and peer-review. It is notable that 40% of surgeons initially approached agreed to participate across a range of experience. This study also creates a mechanism for peer feedback; we hypothesize that feedback could yield broad and meaningful quality improvement. 
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